Download Pre-Op Total Joint Class

Pre-Op Total Joint Class
Welcome!
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Goals
Inform the patient & family what to expect…
 Before, during & after surgery
 Reduce anxiety
 Answer questions
 Help you become better-prepared
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We Care About You!!!
In an effort to personalize your care while in the
hospital, please let us know of any needs ahead of
time
Please complete the enclosed “Care Card” and turn it
in at the end of class
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What To Bring
 List of medications and allergies
 Glasses, hearing aids, dentures
 Toiletry items
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Toothbrush
Toothpaste
 Flat, supportive, non-slip walking shoes (with a
backing)
 Incontinence products (if you use and prefer a specific
product that may not available at the hospital)
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What To Bring
 Night clothes/pajamas, loose clothing
 Books, magazines, hobby items
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Day of Surgery
- Park in parking deck P-2 (To the left of the hospital)
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Infection Prevention
 Chlorhexidine Gluconate (CHG) wipes will be used
to cleanse and disinfect the surgical site before
surgery begins
 Constant handwashing/use of anti-bacterial lotion
 IV antibiotics (before, during, after surgery)
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IV or Intravenous Therapy
 May have one or two lines
 Fluids-body water, blood, antibiotics, pain
medication
 Will leave it in until discharge
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Your Surgery
•Surgery is about 1-2 hours long
•Recovery is about 1 ½ hours
•Staff will page family/visitors once
patient is out of recovery and give the
room number. This is where you will
meet your family/visitors after surgery.
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Welcome to your room!
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After Surgery - Oxygen
 Only used a short time
 Let us know if you have sleep apnea or use
oxygen or CPAP at home
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If so, bring CPAP manual with settings as
prescribed by MD
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Dressings and Drains
 Large dressing initially
 Drains and dressings removed 1st or second
day after surgery
 Dressing changed daily
after that
 Cell Saver
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Foley Catheter To Drain Urine
 Stays in about 1 day
 Helps to keep track of fluid balance
 Good initially when not moving well
 Put in after you are asleep
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Pain Management
Our goal is to keep you comfortable
and functional. It is unlikely that
your pain will be 0.
We ask that you partner with us and
ask for additional pain medicine if
needed
Alternative pain options may be used
such as cold therapy and relaxation
Our staff will make every effort to best
manage your pain.
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PCA - Patient Controlled
Analgesia
 “Pain Button”
 Administer to self
 Close monitoring
 NO ONE IS TO PUSH THE BUTTON EXCEPT
THE PATIENT!!!
***Please ask your surgeon if this is an option he will use for you
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Exparel
 Numbing medication injected into incision
 Only knee patients may receive this
 Helps control pain up to 72 hours after
surgery.
 Will be given other pain medication along
with this method.
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Femoral Nerve Block/Catheter
***Some surgeons prefer not to use this***
 Numbs the front part of the leg from the
groin to the knee
 Stays in about two days
 May cause you to have a “noodle leg”
 Need to wear a knee
immobilizer while standing
or walking
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Knee Immobilizer
 May also wear at night to remind you to keep
the leg straight
 Used for safety reasons
Note: You may or may not walk with the knee immobilizer on while
exercising with a Therapist. However, you should
ALWAYS continue to wear it with Nursing until
you are able to do a full straight leg raise (with no
bend at the knee)
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Cryotherapy - “Polar Care” Device
**Some surgeons prefer to use ice instead of the Polar Care Device**
**Some surgeons may choose not to use the Polar Care Device or ice**
 Sends a cold signal to the brain to help with
pain management
 Helps with pain and swelling
 You take this home with you
(if it is ordered by your surgeon)
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TENS Unit
 Electrical stimulation that helps to
block pain receptors.
May be given to patient prior to
surgery.
Bring to the hospital if you have been
given one by your doctor’s office.
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While You Are Here
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Medications
 Different color and number
 Always ask nurse what meds are for
 “Combination medications” that you may
take at home may be given as separate pills
while in the hospital
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Preventing Pneumonia
 Incentive Spirometer
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Breathe in 10-12 times an hour
while awake
Helps to expand air sacs in lungs
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Preventing Blood Clots
1. Medication (“Blood Thinners”)
2. “Calf Pumps”
3. Walking and Exercising
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Coumadin, Xarelto, Lovenox
***Please check with your surgeon as to
which blood thinner will be prescribed***
 Will help to prevent blood
clots from forming
 Will need to learn how to
take these medications safely
 Will need to watch a video
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Compression Devices
 Foot or calf pumps
 Help to push the blood back into circulation
 Wear them when you are in bed
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Walking and Exercising
 Helps to prevent blood
clots from forming
 Exercise in and out of bed
 Ankle circles, foot pumps,
tightening leg muscles
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Bedside Shift Report
 Takes place @7:00AM and @7:00PM at
shift change
 Promotes patient safety
 Opportunity for patients and/or Caregiver(s)
to ask questions and address patient needs
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Diet
 Initial diet is typically clear liquid
 Diet will be advanced as you can tolerate
 First tray is “house tray”, then you will order
 Constipation because of pain meds
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High fiber
Increase activity
Fluids
 Nausea
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Call for Help
 Never get out of bed
or chair unless you
call for assistance
 Call as soon as possible
 Try to ask for help when a staff member is
already in the room.
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Condition H (Help)
 Dial 3111 and give room number
 Gives family and friends a way to call a
Medical Emergency team to the bedside
 Call if after speaking to the healthcare team
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You notice a change in your loved one’s condition
You still have serious concerns about your loved one’s
condition
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Sleep / Relaxation
 Dial L.O.U.D. (5683) on phone if sleep
disturbed
 Anonymous call
 TV Channels
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Relaxation/Meditation channels
 Free WiFi
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Case Management &
Discharge Planning
Goal: To get you home safely!!!
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Discharge Plan
 Everyone is assigned a Case Manager who
will usually meet with you the day after
surgery
 Average Length of Stay: 1-3 nights
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That means you should be ready for discharge
around the 1st, 2nd or 3rd day after surgery
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Discharge
Sometimes the discharge process can take up to 4 or 5 hours.
We know you’ll be eager to leave the hospital, and we want
to be sure everything’s in place to ensure a smooth and safe
transition.
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Discharge Plan Options:
Home Health & Equipment
 You will choose agency (list provided)
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RN (if on Coumadin)
Physical Therapy (2-3 times/wk)
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Occupational Therapy (if ordered by Doctor)
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 Equipment ordered…
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Rolling Walker
Bedside Commode
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CPM (if ordered by Doctor)
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Support At Home
 You will need support at home for the first
48 hours around the clock
 From there, Home Health will help
determine what your needs are
 Can someone help to make meals for you?
 Pet care?
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Discharge Plan Options:
Short-Term Rehab
Two types of Rehab Facilities…
1. SNF: 1 to 3 hours of therapy/day
Average Length of Stay: 1-2
weeks-as needed
2. Acute: 3 or more hours of therapy/day
Average Length of Stay: 5 - 7 days
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Discharge Plan
Transportation (depends on what is medically necessary)
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Car
Wheelchair Van
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Not covered by insurance
Cost: $55-$120
Ambulance
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Covered by insurance if “medically necessary”
***Your Case Manager will set up your Wheelchair Van or Ambulance for you
(if needed)
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If You Are Going Home…
You may fill your prescriptions at our Plaza Pharmacy
(Located on the First Floor of the hospital)
 Hours of Operation:

Mon-Fri (9:00AM-4:30PM)
 (919) 954-3921
Pick up from the Main Pharmacy on weekends or after
4:30PM (but make payment arrangements with Plaza Pharmacy
during M-F business hours)
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Physical Therapy
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Treatment Sessions
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Seven days/week
Will typically begin the day after surgery
One or two times per day with the PT
Goals will be simply to get you up walking, start
you on an exercise program, and teach you any
appropriate precautions
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Treatment Sessions (cont)
 Sessions will typically be brief, lasting
approximately 30 minutes
 Sessions are tailored for each patient and therefore
will vary from patient to patient
 A few of you may do well enough to walk with
family, but only if approved by your therapist!
 Last visit will usually be morning of discharge
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CPM Machine
***Some surgeons prefer not to use this***
 Continuous Passive Motion machine
 May be used for total knee patients (if ordered)
 Passively bends knee while in bed
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Precautions
Knee Replacement
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Do not stay in one position for longer than an hour
without standing up, walking a short distance, and
straightening and bending your knee
Do not sleep or rest with a pillow or anything under
your knee
Operated leg out in front while sitting or standing
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General Precautions
Hip Replacement
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Do not bend hip past 90 degrees
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Do not cross middle of your body with operated leg
Do not lie on stomach for at least 6-8 weeks after surgery
Do not stay in one position for more than an hour or two
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Homeward Bound Gym
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Preparing for Therapy Now
 General strengthening for arms and legs
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Don’t do anything that would make your
symptoms worse or irritate any other problem
you may have
Chair push-ups can be useful for strengthening
arms and preparing to use a walker or crutches
Walking or riding a stationary bike can improve
your endurance
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Occupational Therapy
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Treatment
 Sessions will usually begin Post-Op Day #1 (the
day after surgery)
 You may not have a session every day
 Instruction will include: lower body dressing, bed
transfers, bedside commode transfers, tub
bench/shower transfers, personal hygiene, and use
of ADL equipment if needed
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Treatment (cont)
 Demonstration of equipment
***Knee patients rarely need this equipment at discharge while most hip patients
do need this equipment at discharge. The Therapist will determine your
specific needs.
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Reacher
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Sock aid
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Bathing sponge
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Helpful Tips
 How to properly carry items in pockets and/or
basket while driving a walker
 Safety in the shower (have someone close by)
 While at home prior to surgery, move low- and
high-lying items to waist level
(i.e. in kitchen/bathroom cupboards, refrigerator)
 Make arrangements to have appropriate-sized car
available for your discharge
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Before Surgery…
Assess your home environment and let the Therapist know the
following once you are in the hospital…
 Tub/Shower (location, height, grab bars)
 Number of steps (outside of home and upstairs)
 Height of bed
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Thank You!!!
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